Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

No Risk Factors

Microbiology

The regimen below provides standard coverage for early onset (≤5 days) pathogens

Early Onset Pathogens

Antimicrobial Treatment

Ceftriaxone 2 G IV Q24h

PLUS

Vancomycin 15 mg/kg IV Q8-12h

Consider pharmacy consult to dose and discontinue if MRSA nasal swab PCR is negative

WITH OR WITHOUT

Azithromycin 500mg IV/PO x 1

  • For atypical coverage

  • Continue if Legionella urinary antigen positive or if clinical suspicion high

OR

Doxycycline 100mg PO Q12h

If Azithromycin cannot be used

Potential PO Transition

Consider transition to oral therapy once clinically improved/stable

  • Depending on causative pathogen, oral options may be even narrower-spectrum than those presented herein

  • Narrowest effective therapy is generally preferred to minimize adverse effects and emergence of resistance

Amoxicillin/Clavulanate 500mg/125mg PO Q8h

WITH OR WITHOUT

Azithromycin 500mg PO Q24h X 3 days

For atypical coverage, if still needed

OR

Doxycycline 100mg PO Q12h

If Azithromycin cannot be used and atypical coverage still needed

Total Duration

7 days

Duration of therapy may be extended (e.g. total 10-14 days) for patients who fail to respond clinically and/or are definitely diagnosed with pneumonia due to non-lactose fermenting gram-negative bacteria (e.g. P. aeruginosa) or Legionella spp.